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Biomedical subjects

C Diehm

Publications and source records attributed to C Diehm.

At least 91 records · Page 5Linked to original sources
PubMed1991

Tissue concentrations of ofloxacin in necrotic foot lesions of diabetic and non-diabetic patients with peripheral arterial occlusive disease.

Six diabetic patients with infected foot lesions (mean age 64 years) and six male patients (mean age 71 years) with ischemic acral ulceration due to advanced peripheral arterial occlusive disease were treated with 200 mg ofloxacin b.i.d. The necrotic margin tissue concentrations of ofloxacin determined by HPLC and confirmed by microbiological assay were in the same range (1.6 to 6.4 mg/kg) as plasma levels (1.6 to 5.9 mg/l). No difference of plasma and tissue concentrations was found between patients with peripheral vascular disease and diabetics, respectively. After three weeks treatment bacterial wound pathogens disappeared in 7 subjects, changed in 4 patients and were resistant in one patient. Clinical improvement appeared in 9 of 12 patients after three weeks of therapy. Satisfactory tissue levels of orally administered ofloxacin were achieved in the infected necrotic tissue area of diabetic and non-diabetic patients with impaired peripheral arterial circulation.

Aged↗
PubMed1990

[Iloprost in the treatment of ischemic tissue lesions in diabetics. Results of a placebo-controlled multicenter study with a stable prostacyclin derivative].

The efficacy of iloprost, a stable prostacyclin analog, was investigated in a placebo-controlled trial in 109 diabetics with ischemic lesions. 56 patients were randomly allocated to iloprost and 53 patients to placebo. Iloprost was intravenously applied for 6 hours daily on 28 consecutive days at an individually tolerated dose up to 2 ng/kg/min. The control group received identical solvent volumes. In addition all patients had an intensive basic, mainly local, therapy. At the end of the treatment in the iloprost group 31 of 50 patients (62%) showed partial (greater than 30%) or total healing of the lesion(s). In the placebo group this was the case in 12 of 51 patients (22.5%). The difference of 38.5% was statistically significant (p less than 0.05, chi 2-test, alpha = 0.05, beta = 0.1). The percentage of patients who were free of pain increased from 23% to 42% (+19%) in the iloprost group and from 38% to 48% (+10%) in the placebo group. After dose-titration iloprost was well tolerated. Flush, headache and abdominal complaints were the most frequent side effects. Heart rate and blood pressure were not influenced and the control of diabetes was not altered.

Adult↗
PubMed1990

Activation and decreased deformability of neutrophils after intermittent claudication.

This study investigated local alterations in neutrophil activation and deformability after intermittent claudication. In 17 patients with one-sided peripheral arterial occlusive disease, neutrophil count, proportion of activated neutrophils (by nitro blue tetrazolium test), and neutrophil filterability as a measure of passive deformability were assessed in the femoral arterial and venous blood of the diseased leg and in the femoral venous blood of the healthy leg (n = 10). The values were obtained at rest, immediately after claudication, and 10 minutes after claudication induced by repetitive toe stands. Immediately after exercise, the arterial and venous blood differences in the diseased leg were 1) neutrophil count, 9% (95% confidence interval [CI], 5-14%; relative increase in the venous blood compared with arterial blood); 2) the proportion of activated neutrophils, 26% (CI, 10-42%); and 3) the neutrophil filterability, -10% (CI, -4% to -15%). At rest and 10 minutes after exercise, neutrophil parameters did not differ significantly between the femoral arterial and venous blood. Furthermore, no arterial and venous blood differences in the neutrophil parameters were found in the healthy leg. In addition to local changes, systemic changes occurred immediately after exercise. In the femoral arterial blood, the total neutrophil count had risen by 13% (CI, 8-18%), the proportion of activated neutrophils had risen by 41% (CI, 25-58%), and average neutrophil rigidity had risen 17% (CI, 11-22%) compared with the values obtained before exercise. At 10 minutes after exercise, all neutrophil parameters were still elevated. We conclude that even short periods of ischemia, as in intermittent claudication, cause local alterations in neutrophil function and distribution.

Arteries↗
PubMed1989

[Iloprost, a stable prostacyclin derivative, in stage 4 arterial occlusive disease. A placebo-controlled multicenter study].

The effectiveness of iloprost, a prostacyclin derivative, was assessed in a placebo-controlled multicentre trial on 101 patients with chronic arterial disease, stage IV. All patients were on a basic local treatment, 53 randomly being assigned to the iloprost group, 48 to the placebo one. Both groups received identical saline infusions, one with the other without iloprost. Infusions were given on 28 consecutive days, iloprost being added at a dose of up to 2 ng/kg.min over six hours. At the end of the treatment period, 32 of 52 patients (61.5%) of the iloprost group and eight of the 47 in the placebo group (17%) had partial or complete healing of ulcers (P less than 0.05), the treatment effect persisting in both groups for a mean duration of at least one year. Iloprost was well tolerated, once individual dosages had been appropriately adjusted. Facial flushes, headache and nausea were the most common side effects. Heart rate and blood-pressure variations did not differ between the two groups.

Adult↗
PubMed1989

Effects of regular physical training in a supervised class and additional intravenous prostaglandin E1 and naftidrofuryl infusion therapy in patients with intermittent claudication--a controlled study.

UNLABELLED: The aim of this study was to investigate if PGE1 i.v.-therapy after active physical training further increases the walking distance in PAOD stage IIb according to Fontaine. 48 outpatients with intermittent claudication underwent a standardized active walking training of about 6 months twice weekly. Afterwards patients were randomly given once daily an i.v. infusion of 60 micrograms PGE1 (3 ampoules prostavasin) or 600 mg naftidrofuryl. The therapy lasted for 3 weeks with the exception of Saturdays and Sundays. Besides laboratory and doppler parameters, painfree and maximum walking distance (treadmill, 10% incline, 3.5 km/h) were determined. RESULTS: Under active physical training the patients' walking distance increased significantly to more than double the baseline levels. Further significant increase of the painfree walking distance was seen after a 3 week treatment with PGE1 from 136 to 270 m (99%) as well as with naftidrofuryl from 117 to 230 m (97%). While this difference was not significant there was a significant difference in favour to PGE1 after the follow-up period (p less than 0.01). In the PGE1-group the painfree walking distance showed a further increase (from 270m to 306m) whereas it decreased in the naftidrofuryl-group (from 230m to 210m). At the same time under PGE1 the ankle/arm index increased significantly in comparison to naftidrofuryl (p less than 0.01). Side effects differed significantly in respect of the frequency and severity. In the PGE1-group in 20.8% of the patients side effects occurred, whereas in 91.6% of the patients in the naftidrofuryl-group side effects were observed. In no case therapy had to be discontinued because of side effects.

Aged↗
PubMed1989

[Comparison of the effectiveness of intra-arterial and intravenous administration of buflomedil in patients with intermittent claudication].

Buflomedil is a vasoactive agent widely used in the treatment of peripheral arterial disease. 42 patients with peripheral obliterative arterial disease (POAD) in the intermittent claudication stage were treated in a randomized controlled study with 200 mg Buflomedil either intraarterially or intravenously. The infusions with this vasoactive agent were given daily for 15 days, on weekends the patients took 300 mg Buflomedil orally twice. Painfree walking distance on a treadmill was below 75 m at entrance. The treatment was controlled by treadmill test and systolic blood pressure gradients. The painfree walking distance was improved in the i.v. group from 38.7 to 91.7 m (+137%); in the i.a. group from 43.4 to 126m (+190%). There was a significant difference between the increases of painfree walking distances in both groups. No changes of doppler gradients occured. The result of this controlled study confirm that i.a. administered Buflomedil increases painfree walking distances more pronounced than i.v. infusions in patients with intermittent claudication due to POAD.

Clinical Trials as Topic↗
PubMed1989

[Epidemiology and pathogenesis of varicosities].

Epidemiologic studies have shown that over 70% of the population in the Federal Republic of Germany have pathologic changes in the peripheral venous system, from which 5% require treatment. In the Basler Study, varicose veins were found in 26% of those 25 to 36 years of age and in 74% of those 65 to 74 years old. In earlier years, according to a questionnaire of the US National Health Survey there was a prevalence of varicose veins of 0.8% in men and 3.5% in women. In a similar study in the United Kingdom, the prevalence was 2.25%, in Denmark 2%. In contrast, in men of the Maori tribe, 36.3% had varicose veins while the women were affected in 47.4% as compared to 21.5% in the white male population and 40.4% in white women. According to the World Health Organization, varicosities are defined as saccular or cylindrical widened superficial veins where the widening may be circumscribed or segmental. In general, the dilatation of the veins is associated with tortuosities. There are various causes of primary varicose veins whereas secondary varicosities are usually due to a postthrombotic condition (Figure 1, Table 1). Primary varicose veins predominantly manifest themselves in the domain of the great saphenous vein and infrequently in the region of the lesser saphenous vein (Figure 2). Lateral branch varicosities are generally an isolated condition. Microvaricosities may appear as a network or arcade-like pattern of intradermal vessels (Figure 3) or reticular with a diffuse, small caliber network in the upper layers of the subcutis (Figure 4). Varicosities of the perforating veins occur subsequent to local incompetence.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1989

Intravenous prostaglandin E1 versus pentoxifylline therapy in chronic arterial occlusive disease--a controlled randomised multicenter study.

In a controlled multicenter study 70 patients with chronic arterial occlusive disease stage IV according to Fontaine's classification were randomised to treatment with prostaglandin E1 (PGE1) or pentoxifylline (PX), administered over 4 weeks. Parameters of effectiveness were the reduction of analgesics, the relief of rest pain according to an analogue scale, the improvement of the ulceration according to an ulcer score and the healing of necrotic area. The results show that both forms of treatment produced a significant reduction in analgesic consumption and rest pain. Moreover in both groups a significant reduction of the ulcer score and healing of the necrotic area were observed. Side effects occurred in six patients of the PGE1-group and in ten patients of the PX-group, which required premature discontinuation of treatment in four patients of the PX-group. The study also demonstrated that PGE1 is more effective in the treatment of severe arterial occlusive disease than PX. With respect to the analgesic consumption, the reduction of ulcer score and the healing of necrotic area a significant difference was found in favour of PGE1. In accordance the six months follow-up examinations showed a marked deterioration in the PX-group opposed to the PGE1-group. The intravenous application of PGE1 over a period of 4 weeks in patients with severe arterial occlusive disease seems to be an effective therapeutical principle.

Aged↗
PubMed1988

Vasodilating effects of celiprolol in patients with peripheral obliterative arterial disease.

Disturbances of peripheral blood supply have hitherto been considered contra-indications to the use of beta-blockers. This is probably due to an initial increase in peripheral resistance seen with these agents. The question of whether beta-blockers should be used with caution, or not at all, in patients with peripheral arterial disease is of considerable clinical relevance, since coronary heart disease and hypertension often coexist with peripheral obliterative arterial disease. The influence of a single 200 mg dose of celiprolol on peripheral blood flow was studied in 17 male hypertensive patients (mean age: 61.4 years) with stage II peripheral vascular disease of the pelvis or upper leg. These patients were then treated with 200 mg/day celiprolol for a period of 6 weeks. Despite abstinence from physical training, the pain-free walking distance improved slightly during treatment, and the blood pressure and pulse rate were both reduced. Celiprolol did not adversely affect peripheral blood flow or clinical symptoms. This new beta-blocker, therefore, should not be contra-indicated in patients with peripheral vascular disease, in the form of intermittent claudication.

Arterial Occlusive Diseases↗
PubMed1988

[Thrombolytic therapy of deep venous thrombosis with rt-PA].

Recombinant human tissue-type plasminogen activator (rt-PA) was given to seven patients with phlebographically documented deep vein thrombosis at a dose of 60-120 mg/day (0.71-1.76 mg/kg body weight/24 h) for 2 to 4 days. rt-PA induced evident recanalization in 6 of 7 cases. The lowest here used dose of 0.71 mg/kg/24 h was thrombolytical highly effective, but a dose of 1.4 mg/kg/24 h and over was accompanied by bleeding from venous puncture sites. Coagulation analysis showed no obvious decrease of fibrinogen, while euglobulin clot lysis time and thrombelastography demonstrated the systemic fibrinolytic activity. Thus, therapy with rt-PA may represent an alternative and effective therapeutic procedure in treatment of venous thrombosis. The initial results make a case for expanded investigational use of rt-PA in patients with deep vein thrombosis to clarify conceivable advantages of therapy with this fibrin selective thrombolytic agent.

Blood Coagulation Tests↗